REVERSE SHOULDER SURGERY
One of the most common causes of shoulder injuries is damage to the rotator cuff -- a group of tendons located just under the shoulder blade. In severe cases, standard surgery can fix the damage. In older people, extensive wear and tear can sometimes leaves the rotator cuff too damaged to repair. Now, a new surgery that can get older patients back in the swing of things.
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A nice walk on a brisk day is nothing for Fritzie Richardson -- even though she's almost 90!
Helen "Fritzie" Richardson
87 years old
"I've exercised pretty much all my life. I've swam. I've ridden bicycles. I've walked. Everything."
She's been swimming for 82 years, but for the past two, a bad shoulder has kept her in the shallow end.
Helen "Fritzie" Richardson
"It was making me very depressed. When I couldn't do my back stroke, you know, which means arm overhead and down, that really bothered me."
Fritzie had a severely damaged rotator cuff caused by years of wear and tear and arthritis. Doctor Anand Murthi says standard surgery was not an option.
Anand Murthi, MD
Orthopedic Surgeon
University of Maryland
Baltimore, MD
"When you don't have a rotator cuff, then you have nothing to compress the ball against the socket."
So Doctor Murthi tried something new -- a reverse shoulder replacement.
Anand Murthi, MD
"This shoulder replacement is based on using your deltoid muscle, which is the outer muscle on your shoulder, and it replaces the rotator cuff tendons."
This is what a standard replacement looks like. If you reverse it.
Anand Murthi, MD
"This is actually the part that goes down your arm bone, and this is the part that actually gets screwed into your socket."
The deltoid muscle raises the bone up and makes the shoulder functional again.
Anand Murthi, MD
"It's actually miraculous the kind of results that these patients will get."
Three months after Frtizie's surgery she was back in the pool swimming her beloved back stroke.
Helen "Fritzie" Richardson
"No pain. Life today is good."
And Fritzie says she plans on swimming right through the next decade of her life.
Doctor Murthi says the replacement wears faster than standard surgeries, so it's not intended for younger people. He says this surgery is meant to help seniors above age 65. Another benefit -- patients can usually leave the hospital within two days of having the surgery.
ROTATOR CUFF TEARS: A rotator cuff tear is a common cause of pain and disability in adults. The rotator cuff consists of four muscles and their tendons. These combine to form a "cuff" over the upper end of the arm. The four muscles originate from the "wing bone" and together form a single tendon unit. The rotator cuff lifts and rotates the arm and stabilizes the ball of the shoulder within the joint.
CAUSES: In older people, rotator cuff tears are usually caused by degeneration. With time, people lose blood supply to the rotator cuff and wear and tear can actually cause the rotator cuff to tear. Anand Murthi, M.D., an orthopedic surgeon at the University of Maryland in Baltimore, says, "The most common thing I see in my practice is rotator cuff tear disease." Rotator cuff tears can be very debilitating. Dr. Murthi says, "If you can imagine not being able to raise your arm away form the side of your body; you can't wash your hair; you can't eat; you can't brush your teeth. Those things of daily life we take for granted, you can't do."
TREATMENT: Normal shoulder replacement surgeries were built to have the rotator cuff compress the ball against the socket to raise the arm up. However, Dr. Murth says: "When you don't have a rotator cuff, then you have nothing to compress the ball against the socket." Because the standard surgery could not be done in people with rotator cuff tears, he says the goal was just to treat the patient's symptoms with anti-inflammatory drugs, physical therapy and cortisone injections. He says: "Once in a while, we could do the traditional shoulder replacement but mainly just for pain relief. They wouldn't get any function really."
REVERSING THE PAIN, REGAINING FUNCTION: Now, there's hope for older people suffering from debilitating rotator cuff tears. The reverse shoulder surgery is designed for people who have exhausted all other means of repair. In a healthy shoulder, the upper arm bone ends in a ball shape that fits into a socket formed by the shoulder blade; the ball and socket form the shoulder. The reverse shoulder surgery actually reverses the anatomy of the shoulder. The prosthesis attaches the ball portion to the shoulder blade, and the socket is placed at the upper arm bone. Dr. Murthi explains, "This shoulder replacement is based on using your deltoid muscle, which is the outer muscle on your shoulder, and it replaces the rotator cuff tendons."
RESULTS: Dr. Murthi says, "It's miraculous the kind of results these patients will get." They often go from not being able to raise their arm at all to gaining up to 170 degrees of elevation. About six weeks after the operation, patients are usually out of their sling and raising their arm up on their own. Dr. Murthi says the mental benefit is just as big as the physical benefit of the surgery. He says: "All of the sudden, you've given them the ability to swim or golf or just do those regular things -- wave, carry their grandkids. They're very happy."
CANDIDATES: The reverse shoulder prosthesis does have a higher wear rate than traditional shoulder replacements. This surgery is not intended for people in their 40's or 50's because it likely won't last their lifetime. However, Dr. Murthi says people above about age 65 are good candidates.
Karen Warmkessel
University of Maryland School of Medicine
655 W. Baltimore Street
Room 14-002
Baltimore, MD
21201
(800) 492-5538
www.umm.edu
Copyright © 2006 Ivanhoe Broadcast News, Inc.
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